Authors: Frank F. Ing, Evan M. Zahn, Ziyad M. Hijazi, Audrey Marshall, Robert H. Beekman, III
Categories: Pioneers in Interventional Cardiology, congenital heart disease, fellowship, interventional cardiology, pioneers in interventional cardiology, training
Source: Journal of the Society for Cardiovascular Angiography & Interventions
Authors: Frank F. Ing, Evan M. Zahn, Ziyad M. Hijazi, Audrey Marshall, Robert H. Beekman
Those who perform pediatric cardiac interventions have clear memories of the teachers and mentors who have had a huge impact on their training and careers. The pediatric interventional community is a relatively small one, and there are only a few early pioneers in the field from North America who are recognized as significantly contributing to the training of fellows over the past 3 decades. This article highlights 5 of those pioneers (Figure 1): Charles E. Mullins at Texas Children’s Hospital, James E. Lock at Boston Children’s Hospital, William E. Hellenbrand at Yale School of Medicine, Lee N. Benson at The Hospital for Sick Children, and Albert P. Rocchini at the University of Michigan.Figure 1The pioneers of pediatric interventional cardiology. (A) Lee N. Benson; (B) Wiliam E. Hellenbrand; (C) James E. Lock; (D) Charles E. Mullins; (E) Albert P. Rocchini.
Congenital heart disease (CHD) interventional fellowship training had its humble beginnings in the late 1970s through early 1980s when interventional training started as part of the categorical fellowship. As the number of devices available increased and the range and volume of CHD interventions grew, Drs Mullins, Lock, Hellenbrand, and Benson each developed an advanced 6-month interventional fellowship in the late 1980s to early 1990s that became a 1-year fellowship in the mid-1990s. Dr Rocchini eventually joined the group and started a dedicated interventional fellowship a few years later. The vast majority of CHD interventional cardiologists who had formal CHD interventional training in North America can be traced back to one of these pioneers, either directly or indirectly through one of their trainees. The following tributes to these pioneers are written by former fellows.
I first met Lee Benson in July 1992 when I began my categorical cardiology fellowship training at the Hospital for Sick Children in Toronto. To say that Lee was intimidating to a young trainee who had his heart set on becoming an interventional cardiologist would be a gross understatement. Lee didn’t intimidate you by yelling at you, throwing things across the room, or insulting you. In fact, in all my time with him, I never saw him do any of those things. All Lee had to do was pause the procedure, slowly turn and look at you, tilt his head down so that his eyes met yours just above his glasses, and say in a very calm and collected way what you could have done better. The only people in that tiny, outdated catheterization laboratory that were scarier than Lee were the incredibly bright battle-hardened group of nurses, the youngest of whom had been there more than 20 years.
It was in this intense environment that I and so many of my colleagues from around the world learned the science and, more importantly, the art of congenital cardiac catheterization from this genius of a teacher. In those early years, above all else, what we learned from Lee was how to organize our thoughts when doing a complex case and how to think 10 steps ahead and of backup plans (plans A, B, and C) before disaster struck, which could be at any moment. While I still marvel at Lee’s technical skills, his real genius and what he has taught so many of us is how to think through these cases. How to manage the direst complications, and when you’ve managed them, still push on to complete a successful case. When I think of all the fellows that Lee has trained from all around the world since then, I can’t even imagine the scores of children who have been saved because Lee taught us how to think.
During my interventional training with Lee (along with Christine Houde—we were his second and third interventional training fellows), due to his stature in the field, we were among the very few centers with access to the latest and greatest devices of the time, which only included the Rashkind patent ductus arteriosus occluder, the Clamshell device, and the Palmaz and Palmaz-Shatz stents. This provided me with the rare and incredibly unique opportunity to observe up close how one of the great clinical researchers of our time objectively, without any bias, worked tirelessly to push our field forward. Lee taught us all about the importance of honesty and integrity when developing new devices and testing them in our patients. He taught us that reporting and publicly speaking about our complications and negative results was as important, if not more important, than talking about our great cases and good results. He showed us and reminded us constantly that we worked for our patients and not for any of our industry partners, as valuable as they are to our work. This is a lesson that has guided my career and is more important now than ever.
Over the decades, I’ve had the good fortune to become good friends with Lee and his wife Cathy, and it’s hard to remember ever feeling intimidated by this brilliant, kind mentor who loves playing the guitar and talking about his ever-growing family. But it’s never hard to remember that the blessed career I have had is due in part to the mentorship of Lee Benson. On behalf of so many, thank you, my friend.
Dr William E. Hellenbrand, or Bill as we all call him, is more than just a mentor—he has been a guiding force in my journey as an interventional pediatric cardiologist. Training under his tutelage was both a privilege and an inspiration. Bill has an incredible ability to blend technical mastery with a deep sense of patient-centered care, making every case a lesson not just in skill but in clinical wisdom. His approach to problem-solving in the catheterization laboratory was methodical yet innovative, always pushing boundaries while ensuring patient safety remained paramount. He has an innate gift for teaching, balancing high expectations with unwavering support and encouraging us to think critically and act decisively.
Beyond the catheterization laboratory, Bill is a mentor in the truest sense—always approachable and always ready with a word of advice or a humorous anecdote to lighten the mood. He has a dry wit that made even the most intense moments manageable, and his calm demeanor is something we all aspired to emulate. I still recall his knack for delivering constructive criticism with a mix of precision and kindness, ensuring that every feedback session left you more confident and capable than before. During one of my first complex interventions with Bill, I hesitated for a brief moment, unsure of my next move. He leaned in and, in his calm but firm voice said, “You know what to do. Trust yourself.” It was a simple statement, but it embodied his philosophy as a mentor—he believed in his fellows even before we fully believed in ourselves. That confidence was transformative, and it has stayed with me throughout my career.
Even after training, he has remained a trusted colleague and friend, someone whose opinion I value immensely. His influence on my career and on the field of pediatric interventional cardiology is immeasurable. Bill didn’t just train fellows—he shaped the future of our specialty, leaving a legacy that will endure for generations.
Before we all started talking so much about mentorship, Jim was an inspiration. Although he dismissively claimed to have little empathic capacity, he had a keen ability to read people and thus to motivate them. Trainees were drawn to pursue interventional cardiology not through promises of career development and mentorship, but rather by feeling the allure of creating new ways to treat heart disease. Faced with a uniquely difficult problem in the lab, somehow a side door would appear, a Hail Mary, a rabbit from a hat. This was his gift to those of us who learned from him. There was a way to make this better, you just had to be clever and creative enough to figure it out. He was “what box?” before outside-the-box was a thing.
Once the lure of interventional cardiology caught your attention, you only became more locked in as you learned. Jim’s impromptu history lessons, as much as his physiology lectures, were all part of the curriculum. These days, we talk about “meeting learners where they are,” and somehow, he instinctively knew how to teach a whole variety of trainees, so long as they were interested in actively learning. Over his many years, Jim trained many of the brightest and hungriest young interventionalists in the field. Each brought many strengths, and Jim found many of our weaknesses. He mapped out our limits and made us strain up against them every day but to summarize his teaching in this way leaves out the perhaps the most important and truly remarkable part for an interventional cardiologist.
When you tried and were not successful, through your own fault or by chance, he gave you the room to grow through it. This is not to say that he gave you a pass on mistakes or misjudgments. Those were always pointed out. But through his own indefatigable optimism or humor or just a subtle acknowledgment of something you actually got right, he let you know it was OK. Many of us have sat across from him in his office, often in an uncomfortable suit as he, in his button-down shirt with sleeves rolled up and tasteful tie, sat back with hands crossed behind his head. There were the 4 Buddhist levels of becoming a great interventional cardiologist. I can’t recall them all now; one had to do with 3-dimensional thinking. The final one was being able to walk back into the laboratory and stand at the table again after a case with a devastating outcome. Anticipating that day and having a mentor who just assumed you were good enough to keep going made it a bit easier to get through.
To the uninitiated, Jim’s expectations were almost comically grandiose. Many of us remember being asked to shepherd some incredibly complex distant referral case through a regulatory approval process for a new procedure with a few days’ notice or being summoned to his office to prepare a 60-minute lecture in presentation-ready form from only a few notes and graphics scrawled onto a handful of printer paper before his flight left tomorrow. It would not be a stretch, however, to contend that these exercises did indeed hone one’s ability to face an unexpected and unfamiliar situation, rapidly acquire and digest the information necessary to resolve it, and deliver the best possible outcome in the short time frame available. Sounds like cath, doesn’t it?
Dr Charles Mullins, known to many simply as “Chuck,” was one of the most beloved interventional masters of the CHD community and commonly recognized as the father of modern pediatric interventional cardiology. He trained more than 150 interventional fellows worldwide in 23 countries and certainly propelled the CHD interventional field forward over more than 4 decades of mentorship. He started the pediatric interventional fellowship in 1990. At that time, it was only a 6-month training, and I was his fifth fellow in 1993.
When I close my eyes and think of Chuck, I see 3
First, I see myself in the catheterization laboratory scrubbed in with Chuck. I recall watching his hands, how he worked the wires, catheters, and sheaths; how he solved what seemed to be difficult obstacles in the laboratory; how he bent and curved wires and used hot water to shape catheters and sheaths so he could advance them from one chamber to the next and how he modified and adapted devices to fit the complex anatomy.
It’s interesting that Chuck’s grandchildren recall with fondness Chuck whistling through his teeth as he approached them. I recall the same sounds with trepidation. When he started to whistle through his teeth in the catheterization laboratory, it was an ominous sign because it meant you were not working fast enough. It was a warning that he would soon scrub in to take over the case. I marveled at how he could quickly come up with a plan B when plan A wasn’t working or how quickly he could remedy an adverse event before it escalated further. No matter how late in the day, the pressure tracings and angiograms obtained had to be pristine, and he was usually the last to remove his lead because he preferred to hold pressure on the groin site, especially in infants.
That was Chuck as an interventionist and as a physician totally immersed in his passion and work. All his fellows witnessed that during their training with him.
Second, I fondly recall when I was a categorical fellow at Columbia considering an interventional fellowship and attended an American College of Cardiology conference at which Chuck spoke in 1992. At the end, I wanted to go up and introduce myself to him. There was a big crowd around him, and I sat in the back and waited until the crowd thinned to finally approach him. Surprisingly, he spent the next 20 minutes explaining why that was a great decision, and we talked about the excitement of new procedures and devices in the field. By the time we finished, I looked around and the entire room was empty. It was just me and him sitting there. I thought to myself, “here I was, a nobody and he was a famous cardiologist, but he spent those 20 minutes with me.” I will forever treasure that memory.
That was Chuck as a mentor and teacher. He truly enjoyed our camaraderie. He was very committed to us and invested much time with us. The relationships he cultivated with us were lifelong, as mentorship evolved into friendship. That’s why it was a common sight to see a crowd gathered around Chuck at conferences. We’ve all witnessed this.
Third, I see myself sitting with him and a bunch of people over dinner. He would have a beer in hand. He has his Texas belt buckle and boots on, and everyone would be paying attention to him as he told amusing stories of his international travels and encounters. It’s like that old EF Hutton commercial on TV where it says, “When EF Hutton talks, everybody listens.”
That was Chuck as a friend. Someone who valued friendship. Someone who loved “a good meal and a good conversation with good friends.” And we have definitely experienced that.
Despite Chuck’s scholarly accomplishments and fame, if you asked him what his greatest contribution to the field was, he would say it’s the fellows he trained. He took great pride in those lucky enough to have trained with him and whose careers he guided over his lifetime. Many of his relationships with his former trainees were lifelong, as mentorship evolved into friendship.
Unfortunately, Dr Mullins passed away in November 2024. While we mourn his loss, we also celebrate the remarkable life he lived and the legacy he leaves behind. He will be missed deeply but will never be forgotten.
In July 1979, I began my first year as a pediatric cardiology fellow at the University of Michigan, coinciding with Dr Al Rocchini's arrival as assistant professor and catheterization laboratory director. In those days, pediatric cardiology fellowships were categorical—specialized catheterization fellowships didn’t yet exist. I quickly discovered that Dr Rocchini was not only a terrific colleague and outstanding cardiologist but also possessed key characteristics of an outstanding (1) deep subject matter knowledge and technical expertise; (2) excellent teaching skills and clear communication; and (3) a commitment to his mentee’s interests and professional development.
Under his guidance, I gained far more than catheterization laboratory expertise. He instilled in me a rigorous scholarly approach to clinical research, protocol development, data analysis, scientific writing, and presentations.
In the late 1970s, there were very few catheter-based interventions other than balloon atrial septostomy; however, we kept busy studying congenital heart pathophysiology and the impact of various physiologic interventions. For example, we evaluated the impact of vasodilators on left-to-right ventricular shunts and on cardiac output in children with left ventricular dysfunction and, conversely, studied the vasoconstrictor effect of oxygen-breathing in children with a dilated cardiomyopathy.
Good fortune struck early in my fellowship during a rotation on the inpatient service. Several infants were admitted in heart failure due to a large ventricular septal defect. I asked why we didn’t use systemic vasodilator therapy given that shunt size is determined by the ratio of systemic to pulmonary resistance. My mentors “Interesting idea…write a protocol to study it.” With Dr Rocchini’s guidance, we developed a protocol to evaluate the acute hemodynamic effects in the catheterization laboratory (these infants all underwent diagnostic catheterizations at that time). As luck would have it, shortly after institutional review board approval, we had a run of infants admitted with large ventricular septal defects whose families consented to the study. In my first year, I had an abstract presentation at the Society for Pediatric Radiology meeting in San Antonio, and by the second year of fellowship, we had 2 publications in *Circulation—*good fortune indeed for a very junior fellow and, importantly, evidence of exceptional mentorship.
In the early 1980s, when the field of interventional pediatric cardiology was in its infancy, Dr Rocchini and I worked together on protocols to evaluate several catheter-based interventions; these were all institutional review board-approved, prospective studies. We studied balloon dilation for postoperative recurrent aortic valve stenosis and coarctation (we started with children whose second surgical option was considered more complex) and later, native aortic valve stenosis, native coarctation, and pulmonary artery stenosis. When implantable devices eventually became available, we studied atrial septal defect occluders, patent ductus arteriosus occluders, and coarctation stents in animal models and in children.
As my career progressed, I could always count on Dr Rocchini to guide me with keen insights (especially regarding physiology) and crystal-clear thinking, always intended to encourage me and to support my professional development. I was truly very fortunate to have found in Al both a mentor and colleague.
From these tributes, a common theme emerges that highlights these pioneers’ passion for teaching, the strive for excellence, and their combined scientific curiosity and scholarly approach that allowed them to use their technical mastery in fearless but methodical innovation. The former fellows describe their clinical wisdom in how they think through unexpected obstacles and handle complications with decisive actions in a calm manner. These pioneers were also honest and transparent about their failures and used them as learning opportunities. Most importantly, their mentor–trainee relationships often progressed to lifelong friendships. The CHD interventional community is forever indebted to these pioneers of the field.